小儿重症腺病毒肺炎混合感染及高危因素分析.docVIP

小儿重症腺病毒肺炎混合感染及高危因素分析 目的了解小儿重症腺病毒肺炎混合感染情况及高危因素分析。 方法 回顾性收集2009年6月至2011年6月重庆医科大学附属儿童医院756例小儿腺病毒肺炎临床资料，对其重症者（216例）进行混合感染病原学及高危因素分析。结果 重症腺病毒肺炎216例患儿中，６个月至２岁者有143例（66.2％），冬春季患病有161例（74.5％）；177例（81.9％）合并其他病原感染，其中74例（34.3％）合并一种致病原感染，最多可达五重感染。216例呼吸道分泌物及血清共检出334株病原，细菌163株（48.8％），以革兰阴性菌为主（124株）；病毒108株（32.3％）；真菌40株（12.0％）。单因素分析显示重症腺病毒肺炎与先天性心脏病、先天性气道发育异常、营养性贫血、反复肺部感染、营养不良及既往有手术史相关（P0.05），Logistic多因素分析显示，先天性心脏病、先天性气道发育异常、营养性贫血、反复肺部感染及既往有手术病史是小儿重症腺病毒肺炎的独立危险因素，OR值分别为3.3、11.1、7.2、14.3、12.9（Ｐ＜0.05）。结论 重症腺病毒肺炎多见于６个月至２岁婴幼儿，冬春季易感,多与其他病原混合感染,以革兰阴性菌为主，前四位为流感嗜血杆菌、大肠埃希氏菌、鲍曼不动杆菌与肺炎克雷伯杆菌；革兰阳性菌中则以肺炎链球菌为主。先天性心脏病、先天性气道发育异常、营养性贫血、反复肺部感染、既往有手术病史是儿童重症腺病毒肺炎独立危险因素。 Objective To investigate the mixed infection and analyze the etiology and risk factors in children with severe adenovirus pneumonia . Methods A retrospective analysis was performed on the clinical data of 756 children with adenovirus pneumonia between June 2009 to June 2011.Pathogens and the risk factors were studied in 216 severe cases . Results Of the 216 severe cases，143（66.2%）were aged from 6 months to 2 years ，and 161(74.5%）developed the disease in winter and spring . 177（81.9％）were affected by 1-4Pathogens besides adenovirus，including 74 cases （34.3%）infected with one pathogen as an addition.A total of 334 pathogenstrains were identified from the respiratory secretions and sera of the 216 cases.dominated by Gram-negative bacteria（124 strains），108 strains(32.3%) were viruses，and 40 strains（12.0%）were funguses.Single chi-square test analysis indicated that congenital heart disease,congenital anomalies airway development, nutritional anemia, frequent lung infection, malnutrition,and previous surgical history were risk factors relevant to severe adenovirus pneumonia. Multiple logistic regression analysis indicated that congenital heart disease,congenital anomalies airway development, nutritional anemia, frequent lung infection and previous surgical history were independence risk factors associated with severe adenovirus pneumonia,